Authors:Cassina C; Papageorgiou S, Eliades T.Abstract: SummaryBackgroundPermanent canines are amongst the teeth most affected by impaction and ectopic eruption. Although impacted canines are often subjected to surgical exposure and alignment with either the open or the closed technique for many decades, their treatment effects have not yet been systematically asssessed.ObjectivesThe aim of this systematic review was to critically assess whether significant differences exist in the outcomes of the open or closed surgical exposure of impacted canines.Search methodsAn unrestricted electronic search of nine databases from inception to December 2016 was performed.Selection criteria methodsIncluded were randomized or prospective non-randomized studies comparing open versus closed exposure of impacted canines in human patients.Data collection and analysisAfter duplicate study selection, data extraction, and risk of bias assessment according to the Cochrane guidelines, random-effects meta-analyses of mean differences (MDs) and odds ratios (ORs), including their 95 per cent confidence intervals (CIs) were performed, followed by subgroup and sensitivity analyses.ResultsA total of eight unique studies and a total of 433 (30.1% male/59.9% female) patients were included, with an average age of 15.2 years and a total of 453 impacted canines (48.6% and 51.4% in the open and closed exposure, respectively). Open exposure of impacted canines was associated with reduced duration of canine alignment (two studies; MD = –2.14 months; 95% CI = –4.23 to –0.05 months; P < 0.05; moderate heterogeneity and moderate quality) and lower odds of tooth ankylosis (one study; OR = 0.15; 95% CI = 0.03–0.83; P < 0.05; low quality) compared to closed exposure; both findings being independent of canine localization. However, initial alignment of palatally impacted canines took overall significantly longer than labially impacted canines (8.87 versus 4.17 months).ConclusionsBased on existing evidence, open surgical exposure seems to be superior in treatment duration and ankylosis risk over the closed technique. Due to the limited number of small included trials, further research is needed for robust clinical recommendations.RegistrationPROSPERO (CRD42016051916).PubDate: Tue, 04 Jul 2017 00:00:00 GMT

Authors:Christell H; Birch S, Bondemark L, et al.Abstract: SummaryBackgroundExamination with Cone Beam CT (CBCT) is common for localizing maxillary canines with eruption disturbance. The benefits and costs of these examinations are unclear.ObjectivesTo measure: 1. the proportion of orthodontists’ treatment decisions that were different based on intraoral and panoramic radiography (M1) compared with CBCT and panoramic radiography (M2); and 2. the costs of producing different treatment plans, regarding patients with maxillary canines with eruption disturbance.Subjects and methodsOrthodontists participated in a web-based survey and were randomly assigned to denote treatment decisions and the level of confidence in this decision for four patient cases presented with M1 or M2 at two occasions for the same patient case.ResultsOne hundred and twelve orthodontists made 445 assessments based on M1 and M2, respectively. Twenty-four per cent of the treatment decisions were different depending on which method the raters had access to, whereof one case differed significantly from all other cases. The mean total cost per examination was €99.84 using M1 and €134.37 using M2, resulting in an incremental cost per examination of €34.53 for M2.LimitationsBenefits in terms of number of different treatment decisions must be considered as an intermediate outcome for the effectiveness of a diagnostic method and should be interpreted with caution.ConclusionsFor the patient cases presented in this study, most treatment decisions were the same irrespective of radiological method. Accordingly, this study does not support routine use of CBCT regarding patients with maxillary canine with eruption disturbance.PubDate: Sat, 24 Jun 2017 00:00:00 GMT

Authors:Verna C; Cattaneo P, Dalstra M.Abstract: SummaryObjectiveTo analyze whether the decreased bone density due to the manipulation of bone remodeling rate has an influence on the type of the planned tooth movement.Materials and methodsA finite element model of a lower incisor has been developed. The density of the alveolar bone surrounding the tooth has been assumed to simulate the one occurring after corticotomy to increase tooth movement rate. Moment-to-force ratios corresponding to three different types of movements have been simulated; uncontrolled tipping, translation, and root movement. The three tooth movements have been analyzed in both corticotomized and non-corticotomized simulations, and the final effects on the amount and type of tooth movement analyzed. The stress and strain levels in the periodontal ligament have been analyzed too.ResultsThe amount of tooth movement obtained in case of lower bone density is higher in all types of movement simulations. The centre of rotation of the movement shifts more apically in case of translation, controlled and uncontrolled tipping. In the corticotomy simulations, the compressive stresses in the periodontal ligament decreased while the tensile stresses increased.ConclusionA decreased bone density influences not only the amount of tooth movement, but also its type. This study suggests that the moment-to-force ratios used in conventional orthodontics should be modified in case of techniques that decrease bone density to enhance tooth movement rate.PubDate: Wed, 07 Jun 2017 00:00:00 GMT

Authors:Koretsi V; Tingelhoff L, Proff P, et al.Abstract: SummaryBackground and aimDigital orthodontic model analysis is gaining acceptance in orthodontics, but its reliability is dependent on the digitalisation hardware and software used. We thus investigated intra-observer reliability and agreement / conformity of a particular digital model analysis work-flow in relation to traditional manual plaster model analysis.Materials and methodsForty-eight plaster casts of the upper/lower dentition were collected. Virtual models were obtained with orthoX®scan (Dentaurum) and analysed with ivoris®analyze3D (Computer konkret). Manual model analyses were done with a dial caliper (0.1 mm). Common parameters were measured on each plaster cast and its virtual counterpart five times each by an experienced observer. We assessed intra-observer reliability within method (ICC), agreement/conformity between methods (Bland–Altman analyses and Lin’s concordance correlation), and changing bias (regression analyses).ResultsIntra-observer reliability was substantial within each method (ICC ≥ 0.7), except for five manual outcomes (12.8 per cent). Bias between methods was statistically significant, but less than 0.5 mm for 87.2 per cent of the outcomes. In general, larger tooth sizes were measured digitally. Total difference maxilla and mandible had wide limits of agreement (−3.25/6.15 and −2.31/4.57 mm), but bias between methods was mostly smaller than intra-observer variation within each method with substantial conformity of manual and digital measurements in general. No changing bias was detected.ConclusionsAlthough both work-flows were reliable, the investigated digital work-flow proved to be more reliable and yielded on average larger tooth sizes. Averaged differences between methods were within 0.5 mm for directly measured outcomes but wide ranges are expected for some computed space parameters due to cumulative error.PubDate: Mon, 22 May 2017 00:00:00 GMT

Authors:Schoen C; Glennon J, Abghari S, et al.Abstract: SummaryBackgroundThe role of microRNAs (miRNAs) in animal models of palatogenesis has been shown, but only limited research has been carried out in humans. To date, no miRNA expression study on tissues or cells from cleft palate patients has been published. We compared miRNA expression in palatal fibroblasts from cleft palate patients and age-matched controls.Material and MethodsCultured palatal fibroblasts from 10 non-syndromic cleft lip and palate patients (nsCLP; mean age: 18 ± 2 months), 5 non-syndromic cleft palate only patients (nsCPO; mean age: 17 ± 2 months), and 10 controls (mean age: 24 ± 5 months) were analysed with next-generation small RNA sequencing. All subjects are from Western European descent. Sequence reads were bioinformatically processed and the differentially expressed miRNAs were technically validated using quantitative reverse-transcription polymerase chain reaction (RT-qPCR).ResultsUsing RNA sequencing, three miRNAs (hsa-miR-93-5p, hsa-miR-18a-5p, and hsa-miR-92a-3p) were up-regulated and six (hsa-miR-29c-5p, hsa-miR-549a, hsa-miR-3182, hsa-miR-181a-5p, hsa-miR-451a, and hsa-miR-92b-5p) were down-regulated in nsCPO fibroblasts. One miRNA (hsa-miR-505-3p) was down-regulated in nsCLP fibroblasts. Of these, hsa-miR-505-3p, hsa-miR-92a, hsa-miR-181a, and hsa-miR-451a were also differentially expressed using RT-PCR with a higher fold change than in RNAseq.LimitationsThe small sample size may limit the value of the data. In addition, interpretation of the data is complicated by the fact that biopsy samples are taken after birth, while the origin of the cleft lies in the embryonic period. This, together with possible effects of the culture medium, implies that only cell-autonomous genetic and epigenetic differences might be detected.ConclusionsFor the first time, we have shown that several miRNAs appear to be dysregulated in palatal fibroblasts from patients with nsCLP and nsCPO. Furthermore, large-scale genomic and expression studies are needed to validate these findings.PubDate: Tue, 09 May 2017 00:00:00 GMT

Authors:Sampaziotis D; Tsolakis I, Bitsanis E, et al.Abstract: SummaryObjectiveThis study aims to compare the effectiveness of two different canine exposure techniques (open and closed) regarding periodontal outcomes, duration of surgical treatment and canine’s eruption, patient’s inconvenience, aesthetics, and orthodontic treatment complications.Search methodsElectronic database searches of published and unpublished literature were performed. The reference lists of eligible studies were hand searched for additional studiesSelection criteriaRandomized clinical trials (RCTs), quasi-randomized clinical trials (Q-RCTs) and non-randomized trials of prospective and retrospective design with patients of any age that compared group with palatally impacted canines treated by open exposure to a similar group treated by closed exposure technique were selected. There was not any restriction in language or year of publication.Data collection and analysisStudy selection, data extraction, and risk of bias assessment were performed individually and in duplicate.ResultsSearch strategy resulted in 159 articles and nine articles were selected for the final analysis. They were three non-randomized trials, one Q-RCT, and two reports of another Q-RCT and three reports of one RCT. The level of reported evidence was high for the RCT and one Q-RCT but poorer for the other trials. Four articles reported periodontal outcomes, three searched the duration of surgical procedure, two the duration of canine eruption, two investigated patient’s inconvenience, two reported on failure rates and two addressed aesthetic outcomes. The results are inconsistent and there is considerable disagreement for the majority of the outcomes among studies.ConclusionAccording to existing articles we may conclude that there is no difference between the two techniques regarding the periodontal outcomes and aesthetic appearance. The surgical procedure is shorter in the open exposure group and the amount of postoperative pain during the first day is similar between the open and closed surgical exposure patients. However, these conclusions are based on two single trials with high level of evidence, while the rest of the studies present high risk of bias.PubDate: Tue, 09 May 2017 00:00:00 GMT

Authors:Algharbi M; Bazargani F, Dimberg L.Abstract: SummaryBackground and objectivesThere is no consensus in the literature regarding which rapid maxillary expansion (RME) design or activation rate benefits the patients the most. Therefore, the primary aim of this systematic review was to see whether there is a difference in the skeletal and dentoalveolar effects of different RME appliances in children and growing adolescents. The secondary aim was to see whether these effects are different when using different activation protocols for these appliances.Data collection and analysisThe search was done in three databases (PubMed, Cochrane Library, and Web of Science). The following inclusion criteria were used: randomized controlled trial, prospective controlled studies, 15 or more patients in each study, human subjects up to 18 years of age, and RME effects had to be assessed by computed tomography/cone beam computed tomography.Study appraisal and synthesis methodsQuality of the methodology was classified according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines as high, moderate, or low.ResultsThe search resulted in 145 titles and abstracts; 109 of them were excluded based on pre-established criteria. Thirty-six full-text articles were assessed for eligibility and 18 of which satisfied the inclusion criteria. Finally, seven articles were deemed eligible for full inclusion and revealed that all appliances and protocols showed significant expansion in the mid-palatal suture. No evidence was found for the cause of dental tipping.LimitationsIn this systematic review, having different age groups in each study and using different anatomical landmarks and outcome measures for assessing the skeletal and dental effects made it difficult to conduct a meta-analysis.ConclusionsThere is moderate evidence that all designs produce significant expansion at the mid-palatal suture. However, lack of studies comparing appliances and protocols has been found. Finally, no evidence-based conclusions could be drawn about the appliance effect on teeth tipping.Implications of key findingsNo appliance appears to be superior when it comes to expansion in the mid-palatal suture. Therefore, the tooth-borne appliance might be preferable until further high-quality studies conclude otherwise.FundingThe project was funded through the Department of Orthodontics, Postgraduate Dental Education Center, Region Örebro County, Örebro, Sweden.RegistrationThis systematic review was not registered in any external databases.PubDate: Tue, 09 May 2017 00:00:00 GMT

Authors:Chen J; Wan J, You L.Abstract: SummaryBackgroundVarious types of orthodontic appliances can lead to speech difficulties. However, speech difficulties caused by orthodontic appliances have not been sufficiently investigated by an evidence-based method.ObjectivesThe aim of this study is to outline the scientific evidence and mechanism of the speech difficulties caused by orthodontic appliances.Search methods and selection criteriaRandomized-controlled clinical trials (RCT), controlled clinical trials, and cohort studies focusing on the effect of orthodontic appliances on speech were included. A systematic search was conducted by an electronic search in PubMed, EMBASE, and the Cochrane Library databases, complemented by a manual search.Data collection and analysisThe types of orthodontic appliances, the affected sounds, and duration period of the speech disturbances were extracted. The ROBINS-I tool was applied to evaluate the quality of non-randomized studies, and the bias of RCT was assessed based on the Cochrane Handbook for Systematic Reviews of Interventions. No meta-analyses could be performed due to the heterogeneity in the study designs and treatment modalities.ResultsAmong 448 screened articles, 13 studies were included (n = 297 patients). Different types of orthodontic appliances such as fixed appliances, orthodontic retainers and palatal expanders could influence the clarity of speech. The /i/, /a/, and /e/ vowels as well as /s/, /z/, /l/, /t/, /d/, /r/, and /ʃ/ consonants could be distorted by appliances. Although most speech impairments could return to normal within weeks, speech distortion of the /s/ sound might last for more than 3 months. The low evidence level grading and heterogeneity were the two main limitations in this systematic review.ConclusionsLingual fixed appliances, palatal expanders, and Hawley retainers have an evident influence on speech production. The /i/, /s/, /t/, and /d/ sounds are the primarily affected ones. The results of this systematic review should be interpreted with caution and more high-quality RCTs with larger sample sizes and longer follow-up periods are needed.RegistrationThe protocol for this systematic review (CRD42017056573) was registered in the International Prospective Register of Systematic Reviews (PROSPERO).PubDate: Wed, 03 May 2017 00:00:00 GMT

Authors:AlSayed Hasan M; Sultan K, Hamadah O.Abstract: SummaryBackgroundNo randomized controlled trial before has evaluated the role of low-level laser energy in its analgesic effects in orthodontics.ObjectiveTo evaluate the effect of single application of low-level laser with 4-Joule or 16-Joule energy on pain reduction following elastomeric separators placement.Trial designA two-arm parallel-group single-blind placebo-controlled randomized controlled trial, with implementation of split-mouth technique in each group.Materials and methodsTwenty-six patients in need of orthodontic treatment with a fixed orthodontic appliance were enrolled and randomly allocated to either the 4-Joule or the 16-Joule laser energy group. Elastomeric separators were applied for the mandibular first molars. For each patient one molar received a single low-level laser dose using an 830-nm Ga-Al-As laser device with either 4-Joule or 16-Joule laser beam energy, while the other molar received a placebo treatment by applying the laser device in the same method and parameters as the counterpart molar without emitting the laser beam. The molar to be irradiated was also randomly chosen using simple randomization technique. Allocation was concealed and patients were blinded to which side would receive the laser irradiation. Main outcome measure was the degree of pain scored during mastication for each mandibular first molar after 1, 6, 12, 24, 48, and 72 hours of both laser and placebo treatments application. A questionnaire with an 100-mm Visual Analogue Scale (VAS) was used for pain assessment.ResultsThirty-six patients were evaluated for eligibility, 10 of them were excluded making the final randomized number 26 patients. One patient dropped out later for not completing the questionnaire. Accordingly, the results of 25 patients were statistically analysed. No statistical significance was found for both low-level laser energy values in comparison to the corresponding placebo treatments. No harms were encountered.LimitationsIntervention provider was not blinded to the intervention.ConclusionLow-level laser therapy, applied at two different laser energy values, is ineffective in relieving elastomeric separators induced orthodontic pain.Trial registrationThis trial was not registered.FundingNo funding to be declared.PubDate: Tue, 02 May 2017 00:00:00 GMT

Authors:Almotairy N; Pegelow M.Abstract: ObjectivesTo determine and compare the differences in dental age (DA) and chronological age (CA) of Demirjian and Willems methods in 9- to 11-year-old Caucasian boys and girls born with non-syndromic unilateral cleft lip and palate (NSUCLP) to an age-matched control group. Analysis of the results is undertaken to determine whether there are differences between gender, groups, and methods.Materials and methodsDental panoramic tomograph (DPT) of 108 children with NSUCLP aged from 8.79 to 10.99 years (x¯=10.05 ± 0.36) were compared to 107 control children. Age, gender, and group were blinded during examination. The Demirjian and Willems methods were used by both authors to visually examine the radiographs. Differences between DA and CA were determined with a repeated two-way ANOVA.ResultsInter-examiner reliability was good (ICC ≈ 0.75). For each of the methods used, the mean DA/CA difference was greater in the control group than in the NSUCLP group (P = 0.011). The control group’s Demirjian mean DA/CA difference was 1.08 years and Willems mean was 0.46 years, compared to the NSUCLP group’s Demirjian mean DA/CA difference 0.83 years and Willems mean 0.22 years. Only the Willems method determined a statistically significant gender difference (P = 0.000).ConclusionsThe null hypothesis was rejected. Willem’s method as compared to Demirjian’s displayed greater accuracy in estimating CA. Both methods overestimated CA but detected DA delay in NSUCLP children compared to the control group. However, the methods were inconsistent in estimating gender CA.PubDate: Tue, 02 May 2017 00:00:00 GMT

Authors:Chen H; van Eijnatten M, Aarab G, et al.Abstract: SummaryObjectiveTo assess the accuracy of five different computed tomography (CT) scanners for the evaluation of the oropharynx morphology.MethodsAn existing cone-beam computed tomography (CBCT) data set was used to fabricate an anthropomorphic phantom of the upper airway volume that extended from the uvula to the epiglottis (oropharynx) with known dimensions (gold standard). This phantom was scanned using two multi-detector row computed tomography (MDCT) scanners (GE Discovery CT750 HD, Siemens Somatom Sensation) and three CBCT scanners (NewTom 5G, 3D Accuitomo 170, Vatech PaX Zenith 3D). All CT images were segmented by two observers and converted into standard tessellation language (STL) models. The volume and the cross-sectional area of the oropharynx were measured on the acquired STL models. Finally, all STL models were registered and compared with the gold standard.ResultsThe intra- and inter-observer reliability of the oropharynx segmentation was fair to excellent. The most accurate volume measurements were acquired using the Siemens MDCT (98.4%; 14.3 cm3) and Vatech CBCT (98.9%; 14.4 cm3) scanners. The GE MDCT, NewTom 5G CBCT, and Accuitomo CBCT scanners resulted in smaller volumes, viz., 92.1% (13.4 cm3), 91.5% (13.3 cm3), and 94.6% (13.8 cm3), respectively. The most accurate cross-sectional area measurements were acquired using the Siemens MDCT (94.6%; 282.4 mm2), Accuitomo CBCT (95.1%; 283.8 mm2), and Vatech CBCT (95.3%; 284.5 mm2) scanners. The GE MDCT and NewTom 5G CBCT scanners resulted in smaller areas, viz., 89.3% (266.5 mm2) and 89.8% (268.0 mm2), respectively.LimitationsImages of the phantom were acquired using the vendor-supplied default airway scanning protocol for each scanner.ConclusionSignificant differences were observed in the volume and cross-sectional area measurements of the oropharynx acquired using different MDCT and CBCT scanners. The Siemens MDCT and the Vatech CBCT scanners were more accurate than the GE MDCT, NewTom 5G, and Accuitomo CBCT scanners. In clinical settings, CBCT scanners offer an alternative to MDCT scanners in the assessment of the oropharynx morphology.PubDate: Thu, 27 Apr 2017 00:00:00 GMT

Authors:Drosen C; Bock N, von Bremen J, et al.Abstract: SummaryObjectiveThe aim was to assess the long-term effects of Class II malocclusion treatment with the Herbst appliance on the pharyngeal airway (PA) width in comparison to untreated individuals with Classes I and II malocclusion.MethodsLateral cephalometric radiographs of 13 male Class II patients from before (T1) and after (T2) treatment with the Herbst appliance as well as after the end of growth (T3) were retrospectively analyzed and compared to two untreated age- and gender-matched samples with Class I (n = 13) or Class II (n = 13) malocclusion. The PA dimensions were measured using the parameters p (narrowest distance between the soft palate and the posterior pharyngeal wall) and t (narrowest distance between the base of the tongue and the posterior pharyngeal wall). In addition, standard cephalometric measurements were performed.ResultsRelevant changes in PA dimensions were only seen for the post-treatment period, during which the distances p and t showed a significant increase in the Herbst group only (∆p: 2.3 mm, ∆t: 3.3 mm) while remaining similar in both untreated groups (∆p: 0.5 mm, ∆t: 0.5 mm, respectively, ∆p: 0.7 mm, ∆t: 1.6 mm). During the same period, posterior face height showed a significantly larger increase in the Herbst group than in both control groups (8.2 versus 5.8 mm, respectively, 5.4 mm), whereas anterior face height (NL-Me) showed a similar development in all groups (4.6 versus 4.4 mm, respectively 3.2 mm).ConclusionIn the long term, Herbst treatment resulted in a significant post-treatment increase of PA width, possibly due to an increased lower posterior facial height development compared to untreated individuals.PubDate: Thu, 27 Apr 2017 00:00:00 GMT

Authors:Ganzer N; Feldmann I, Liv P, et al.Abstract: SummaryBackgroundSerial 3D models can be used to analyze changes, but correct superimposition is crucial before measurements can be assessed. Earlier studies show that every palatal structure changes due to growth or treatment. Here, we describe a new method that uses an algorithm-based analysis to perform superimpositions and measurements in maxillary 3D models. This method can be used to identify deformations. In a second step, only unchanged areas are used for superimposition.ObjectivesThis study investigates the validity and reliability of this novel method.MethodsDigital 3D models from 16 cases were modified by an independent 3D engineer to simulate space closure and growth. True values for tooth movements were available as reference. Measurements and repeated measurements were performed by four observers.ResultsThe total tooth movement had an absolute mean error of 0.0225 mm (SD 0.03). The intraclass correlation coefficient (ICC) was 0.9996. Rotational measurements had an absolute mean error of 0.0291 degrees (SD 0.04 degrees) and an ICC of 0.9999.LimitationsSerial models need to be taken with a moderate interval (1 to 2 years). Obvious changed areas in the palate need to be cropped before processing the models.ConclusionThe tested method is valid and reliable with excellent accuracy and precision even when changes through growth or orthodontic treatment occur.PubDate: Sat, 22 Apr 2017 00:00:00 GMT